[Triple-valve prosthesis (old problems, new prospects)].

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Disease
• Rheumatic Heart Disease

Background:

• Rheumatic heart disease frequently affects multiple heart valves.
• Tricuspid valve involvement in rheumatic heart disease poses surgical challenges.
• Prosthetic valve replacement is a critical intervention for severe valvular dysfunction.

Purpose of the Study:

• To analyze outcomes of mitral, aortic, and tricuspid valve prosthetics in patients with trivalve rheumatic heart disease.
• To evaluate the impact of preserving tricuspid subvalvular structures during valve replacement.
• To assess the efficacy and safety of tricuspid valve prosthetics as an alternative procedure.

Main Methods:

• Analysis of 30 prosthetic operations for mitral, aortic, and tricuspid valves.
• Inclusion of patients with significant tricuspid valvular disease (29/30 patients).
• Application of techniques preserving tricuspid subvalvular structures in 18 patients.
• Utilized various prosthetic valve models (ball, semispherical, biological, disk).

Main Results:

• Hospital mortality was 16.7%, with a long-term mortality of 4%.
• 86% of patients experienced improvement of two or more functional classes.
• Preservation techniques for the tricuspid valve apparatus facilitated optimal right ventricular function.

Conclusions:

• Tricuspid valve prosthetics is a feasible and effective alternative, particularly for critically ill patients with trivalve rheumatic heart disease.
• Subvalvular structure preservation in tricuspid valve replacement enhances right ventricular function.
• Surgical intervention for trivalve disease can significantly improve long-term prognosis and functional status.